Should patients fire their doctors if they suspect burnout?

In a recent PBS interview, Mayo Clinic CEO Dr. John Noseworthy suggested patients should “change physicians” when faced with non-empathetic doctors suffering from burnout. His cavalier resolution to our occupational struggle feels like a betrayal, to both his esteemed colleagues across the country and our profession. In my opinion, firing your physician is a risky proposition in light of the looming physician shortage.

Burnout is an overwhelming sense of disillusionment a physician experiences when the practice of medicine holds no joy. It is not a psychological problem, yet can lead to a downward spiral of impairment. According to a recent article in US News, almost half of physicians have symptoms of burnout. Seven percent of physicians aged 29 to 65 contemplated suicide in the last year. These statistics are troubling on many levels.

Over half of current physicians state, if given the opportunity to choose again, they would not choose medicine as a career. Why? Our once noble profession has lost its magnificence in an explosion of technology, nonsensical regulations, and increased clerical burden. According to a study in the Annals of Internal Medicine, for every one hour of patient contact, a physician spends two hours doing administrative work. Never-Had-a-Bad-Day-Noseworthy said, “EHR’s are not easy to use.” Why are physicians being required [forced] to utilize useless technology if it does not reduce burnout while improving efficiency and care quality?

Look, we sacrificed our youth seeking delayed gratification that may never come; physicians have responsibility, but no authority, and vast quantities of knowledge, yet no autonomy. Sadly, we have ceded it to arrogant administrators running amok in a system of unfettered capitalism. Regrettably, this oppression has taken a toll on us all, patients included.

How did physician burnout become linked to increased medical errors? A study examined the relationship between the burnout experienced by surgeons and frequency of medical errors. The more exhausted and depersonalized your physician has become the greater your likelihood of experiencing a medical error.

How common are these so-called medical errors? Last May, the British Medical Journal released a study ranking medical errors as the third leading cause of death in the U.S., after heart disease and cancer, killing 250,000 people a year. From my perspective, an overwhelming workload also plays a significant role. A recent study in JAMA found increasing a nurses’ workload from four to six patients increases the death rate by 14 percent, while going from six to eight patients is tied to a 31 percent increase in death rate. The wheel is turning, but the hamster is dead, literally.

If a physician is suffering from burnout, let us walk through the conversation Dr. Noseworthy is so naively proposing.

Patient: “Doc, You are not as empathetic as you used to be. I am thinking about changing physicians?”

Physician: “Well, what exactly is the problem?”

Patient: “Well you used to spend more time with me at appointments and seemed to care.”

Physician: “I wish there was more time to talk. I sure loved my job back then …” (Sigh. Continual tapping of computer keys heard in the background while trying to seem empathetic.)

Valuing the physician-patient relationship allows it to be a central transformative therapeutic force. Obamacare expanded coverage for almost 20 million Americans seemingly overnight. Patient volumes doubled due to the unprecedented surge in insurance coverage? There were not enough physicians in reserve to care for the overwhelming onslaught especially in underserved rural areas; most of us on the front lines are drowning in paperwork, administrative and regulatory burdens. Being a physician under current circumstances is like trying to get a sip of water out of a fire hose. Every physician in this country is on the train barreling toward burnout.

Last week, I referred four different patients to four different local pediatric specialists. Three of those four physicians called to let me know they are retiring at the end of the year. With all due respect to Dr. Noseworthy, at the rate things are going, firing your physician will land a patient in medical limbo until they can find a physician desperate enough to accept them. This man is so out of touch with reality outside the ivory tower, he is completely oblivious to the larger implications of the looming physician shortage.

According to the Association of American Medical Colleges report, the projected shortage will reach 85,000 physicians by 2020. In “Will the Last Physician in America Please Turn Off the Lights,” three co-authors from Merritt, Hawkins & Associates say the wait to see a physician will jump to three to four months for a non-emergent visits, and it will cost two to three times what it does now–whether you are insured or not. Guess what? I am already at the three-month mark for non-emergent appointments and struggling to keep up with the growing patient demand.

Physicians are resilient to a fault, coupled with stoic demeanors, inquisitive minds, and strongly empathetic natures, but we all have our limits. Reducing burnout will only be feasible when we have more independence over the particulars of our self-sacrificing occupation. If every physician in this country insisted on caring for patients as we saw fit and refused to click even one more box, a revolution would ensue. We must stop “rolling over” when asked to do more with fewer resources, reduced pay, and even less time. Physicians must put on their own oxygen masks before helping others with theirs.

Despite his insulting recommendation, Dr. Noseworthy might actually be on our side. “Physicians are highly dedicated professionals, who are good people, but have been crushed [by the system.]” Do not allow yourself to be destroyed by a system we cannot control. Take back medicine for yourself and your patients. Know your value. Do not bend to the demands of managers and administrators; refuse to accept a workload that prohibits attaining occupational jubilation and enlightenment.

There is an impending crisis no one has foreseen; the winds are about to shift in our direction. Rules of supply and demand are universal. Soon, it will be a “physicians market”; we will cherry pick patients based on their having good insurance, a healthy medical profile, and a pleasant demeanor.

Let us circle back to Dr. Noseworthy, “Change physicians. It is too risky to be cared for by someone who is impaired.” You know what is more risky than that? It is having no physician at all when you desperately need one. My advice is to build a relationship with a physician while you still can. If your physician is not empathetic or appears to be suffering from burnout, my cautionary recommendation is to be careful what you wish for, because you just might get it.

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Should patients fire their doctors if they suspect burnout? 10 comments

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NewMexicoRam

I’d say the Mayo Clinic CEO needs to quit his job and become a practicing physician again.
Or is he afraid of “burnout?”

Niran Al-Agba

Agreed. You know and I know he would never make it in the trenches.

Niran Al-Agba

Thank you. I pretty much agree with everything you said. After last nights events, never say never for anything.

Niran Al-Agba

Of course it is. He has nothing on the line.

Niran Al-Agba

Exactly.

meyati

This should be required reading for every person that’s starting Medicare or MediCaid. Do you realise that where I live it’s easier to find a veternarian that can read an out-of-range thyroid lab report than a physician? So, that reduces my options even more. don’t laugh–i had 5 doctors that read my out-of-range labs-too high-and they increased my dosage. My BP is down now, my eyebrows returned, etc.

Meanwhile the administration of my Advantage Plan Network are playing shell games to pass expenses off to another department.

Niran Al-Agba

You live in a location that is similar to mine in regard to physician shortage. This will become the future and many more communities if something doesn’t change. I wish president elect Trump was reading this. It would be a great place to start.

meyati

On an article in Becker’s Hospital Review, I commented that this could be a good time for doctors to petition Trump about some of the problems that cost so much money and raise health care costs, while causing patient disatisfaction and physician burnout.

#1—Stop fining physicians that don’t use EMRs-the ones that don’t use EHRs won’t be persecuted nor stressed-Let the market place decide the issue-and I’m a liberal Democrat
#2—Have a doctor talk to a patient about the life style goals—losing weight, diabetes prevention-I had a PCP who lost his license because he tried to get me to lose weight-change my diet and told me that I was a diabetic-I am a small head cancer patient that had to gain 20 lbs to survive radiation, etc. My radiology oncologist finally took charge. CAN’T A PATIENT SIGN OFF ON THESE THINGS? WHY ARE PHYSICIANS AND PATIENTS STRESSED OUT?

sign off on BP- weight- diet- gym exercise (I do that at home)- cholesterol (I was poisoned by statins)-

petition that the doctor actually cares for the patient’s actual problems that generated the visit

i have a wonderful Saudi doctor now. She actually can read a TSH–she reduced my THS dosage to the perfect level the very first attempt—-my BP went down, 120/80 and I’m 74, my body temp actually went down to normal- lots of little things that make my life better.

Niran Al-Agba

You are talking about individualized care for people. Yes, that is the way it used to be until all the middlemen got involved who do not practice medicine. Patients can sign off to refuse immunizations but it still does not get us off the hook. Physicians are penalized for lower rates as providing low quality care. We need a revolution!

meyati

it’s worse-my hospital network seems to be failing, so it decided to invent questions to look good to NIH and Medicare. I went in-and I refused to answer these extra questions. I did tell them loudly- “NO, I haven’t been to Miam or Floridai” The poor clerk said, “We didn’t ask you that, and we have to ask you these questions to improve medical care.” I said, ‘Well it seems this place should be concerned about ZIKA. as a health issue” They stopped asking the other questions, and now ask about travel to American tropical areas. They even stopped asking some of the questions that I thought were truely mandated.

One of the reasons that I took statin was because I felt sorry for my old PCP that he couldn’t get 80% of patients on statin. I actually had a seizure in his office from that, besides my Achilles tendons going out. I can walk unassisted now, but–I had lots of physical therapy-I was lucky they sent me to a specialist that also has Statin toxicity-and he is lucky to totter around his office. Silly me– i thought that I’d get a rash or something.

I am saying–Patient satisfaction should really include respect for a patient’s decision without a physician being financially punished. That is part of the patient-physician disconnect, and why a patient isn’t really treated for the complaint that causes the doctor visit. -sore throat—sprained ankle–etc. Why can’t the annual visit that’s touted cover- Are you exercising? I see that you you gained-lost weight? Was that intended? Do a fecal occult, especially if the patient has IB.

They say the EMR is about $40,000 a year for each physician-and they really don’t connect to each other or help the patient much. How many doctors use and pay $40,000? My doctors spend about $240,000 a year to track me-unsuccessfully. I found out last month that the oncology clinic uses the EMR to track any calls that I make to a counselor-but it didn’t track the calls trying to connect to someone, because I was losing bone-getting a small hole in the radiation area. My ENT took hysterical me in-gave me antibiotics which seems to have resolved the issue. Head cancer- nose-mouth-in remission for a rare incurable. My eye doc and dermalogist don’t share or get records from anybody else. This EMR system can’t even be programmed to list “as needed” meds-or differentiate daily meds-thyroid from as needed—no- I don’t take a high powered cough syrup daily. Maybe all of the unhappy doctors could cut national health costs by getting rid of the EHRs—

Anyway– don’t let them cut your pay because I don’t want statin or I exercise at home instead of a monitored health program–